| NPI | 1386651040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1199151) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 2329) |
| 225100000X Physical Therapist (Licence: UT 3592542401) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2010-08-30 |